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is patient compliance the same as patient responsibility?

Discussion in 'United Kingdom' started by omg 123, Apr 2, 2014.

  1. omg 123

    omg 123 Member


    Members do not see these Ads. Sign Up.
    we all want the patient to comply with treatment plans and advice but what is the patients responsibility?

    Is the patients responsibility supported in law of a common sense thing?

    How do we best note failure to comply with a treatment plan and what is the exact meaning of patient responsibility?

    Any opinions?
    :D
     
  2. Suhail

    Suhail Member

    Firstly 'compliance' suggests that patients should do as we, the health professionals, advise them to do so and that they do not have a say. I understand there has been a shift in this terminology/concept and it is now being branded as 'patient adherence' as our approaches become more patient centred.

    Patients should be seen as 'partners' in the development of their treatment plan, where together we are able to set goals and agree on a treatment pathway. As qualified professionals we're be able advise them on how realistic these goals are and how we can realise them and any risks and benefits involved (including patient responsibility).

    It would seem that in this approach patient adherence is concomitant to patient responsibility.

    We have a duty to the patient to provide the best and most appropriate care as required. The patients also have an equally important duty of care to themselves. A treatment plan in which the patient has been a 'partner' is essentially a contract. I'm no medico-legal expert, but one would assume that the law would see that a patient has failed to make reasonable efforts to

    It places an ownership over ones own health, rather than an expectation for someone else to resolve the problem for them.

    For so long in the UK many health professionals have felt an ownership over a patients care with a very admirable desire to ensure the patient is well and in the best if health. This has inadvertently created a culture in which patients have become increasingly reliant on services and professionals to do things for them, when in fact they should really be empowered to self-care where possible and appropriate.

    It's certainly time that patient responsibility is brought to the forefront.

    How often do we have increased/high risk patients who miss their appointment for no valid reason, who are then re-scheduled to be seen either during your lunch hour, before/after a full clinic and still don't turn up until you've packed ip and on the way out??!

    If it wasn't for the good will of the staff in the NHS it wouldn't exist!

    Those are just a few of my rather long winded opinions/ideas, I'm no expert but it would be interesting to hear the thoughts of others.
     
  3. Deka08

    Deka08 Active Member

    Excellent post Suhail. I totally agree.
    If a patient is not compliant, then sometimes we need to step back and look at why, and what could we be doing better. Probing the matter can often expose deeper reasons, and therefore better education and outcomes. Telling someone to do something and educating them why are very different things.
     
  4. Simon Ross

    Simon Ross Active Member

    I had a T2 diab patient who had callous at breakdown stage as well as tinea pedis.

    The GP surgery had told the patient that the callous "may need a little scraping", when I said that it did need to be done, I was told (2 weeks later by the patient) that they found my attitude a bit pompous at that moment in time).

    When I showed them (taken from Neil Baker's EXCELLENT conference talks) slides showing what can happen if things go wrong, they saw that I was not being pompous, but I was in the right.

    Yes, I showed him visuals to show why I was not overreacting, he respected me, and thought that I was being a top bloke.

    If you educate these patients with visuals/facts, a kind of form of motivational interviewing, you can change people's behaviour.
     
  5. Here's a different (non-NHS) version of a patient- centred approach.

    1. Ask patient what the problem is and how you can help them.
    2. Listen to patient.
    3. Fix problem.
    4. Thank the patient for asking you to help them.

    It's very satisfying for the patient and the clinician and another thing is that it's completely non-judgmental. Sure you advise them if they're doing anything to cause or exacerbate the problem, but, hey, that's their choice and of course, you're not going to complicate matters for them by withdrawing your care. So job well done.
     
  6. DAVOhorn

    DAVOhorn Well-Known Member

    Dear All,

    This is one of those chicken and egg situations.

    The patient is sat in front of you.

    Why is the patient there?

    Are they there because they want to see you , or are they there because somebody else referred them.

    I usually go on the presumption that if they are sat in front of me then they want to see me.

    So approach their presence in this matter.

    You then ask How can I help ???? This is a simple open question and the reply can be anything.

    From this reply you can then steer the following questions to formulate a diagnosis and a prognosis which results in a treatment plane.

    I have always found that advice given to the patient, so that they can change how they behave towards the problem is the best place to start. This gives them a degree of responsibility and ownership of the problem. It also reinforces that you are there as a part of a partnership in the over all problem.

    I feel that in many cases the clinician takes control of the problem, forgetting that the patient is attached to the presenting problem.

    I have found over the years that if you fail to engage the patient in this partnership then you will find yourself Micturating Into The Breeze :bash: . The outcome will thus not be what either party had hoped for. You would then find that the person at fault is the clinician and not the patient.

    Over the years we clinicians will find our selves as the patient in another environment and I wonder how well we behave when a clinician is giving us advice and asking us to make lifestyle changes???? :deadhorse:

    I recently had a minor problem that required me to change certain aspects of my lifestyle. it was a simple choice change or risk major health complications in years to come. So I changed my behaviour. many will not and in 10 years may return to complain that you failed to make a decent argument for them to change.

    So the patient has a duty of care to their own well being based upon advice given to them by a variety of Health Care Professionals.

    We have a duty of care to make the point that it is their body and quality of life that are at risk and that encouraging change is our duty of care.

    You can lead a horse to water but you cannot make it drink :deadhorse:

    So in reply to the question the patient has a responsibility to comply with advice given. :drinks

    Regards David
     
  7. Greg Fyfe

    Greg Fyfe Active Member

    omg123
    If your wanting to document "non compliance" I'm thinking you have to nonjudgementally note that the patient does not appear to have followed the plan.

    As for "patient responsibility" perhaps it's to...make a choice.

    It may not be what you would choose for them, often their day to day reality influencing the choices they may make is quite different to the health professionals.

    Plenty to think about there.

    Regards
    Greg
     
    Last edited: Apr 7, 2014
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